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Ischemic Stroke
Original research
Relationship of white matter lesion severity with early and late outcomes after mechanical thrombectomy for large vessel stroke
  1. Zimbul Albo1,
  2. Jose Marino2,
  3. Muhammad Nagy2,
  4. Dilip K Jayaraman2,
  5. Muhammad U Azeem2,
  6. Ajit S Puri3,
  7. Nils Henninger4
  1. 1 Neurology, University of Massachusetts Medical School, Worcester, Massachusetts, USA
  2. 2 UMass Memorial Medical Center University Campus, Worcester, Massachusetts, USA
  3. 3 Radiology, University of Massachusetts, Worcester, Massachusetts, USA
  4. 4 Department of Neurology, University of Massachusetts Medical School, Worcester, Massachusetts, USA
  1. Correspondence to Professor Nils Henninger, Department of Neurology, University of Massachusetts Medical School, Worcester, MA 01655, USA; Nils.Henninger{at}umassmed.edu

Abstract

Background White matter lesions (WML) are associated with poor outcome after mechanical thrombectomy (MT) for large vessel stroke; the reasons are uncertain. To elucidate this issue we sought to determine the association of WML with multiple early and late outcome measures after MT.

Methods We retrospectively analyzed 181 MT patients prospectively included in our local stroke registry (January 2012 to November 2016). Using multiple regression modeling, we assessed whether WML was independently associated with early outcomes (successful recanalization, degree of National Institutes of Health Stroke Scale (NIHSS) improvement, hemorrhagic transformation, duration of hospitalization) as well as an unfavorable 90-day modified Rankin Scale score (mRS) (≥3) and 90-day survival. Explorative analyses examined the association with the 90-day home-time and 90-day risk for hospital readmission.

Results WML were not significantly associated with early outcome measure (P>0.05, each). Patients with moderate-to-severe WML more often had an unfavorable mRS (OR 2.93, 95% CI 1.04 to 8.33) and risk of death (HR 1.98, 95% CI 1.03 to 3.84) after adjustment for pertinent confounders. Patients with moderate-to-severe WML had a significantly shorter home-time (19±32 vs 47±38 days, P<0.001) and Kaplan–Meier analyses indicated a significantly greater risk for hospital readmission within 90 days (log rank P=0.045), with the most frequent reasons being recurrent stroke and transient ischemic attack.

Conclusion Our analyses suggest that poor outcomes among patients with moderate-to-severe WML were related to factors unrelated to procedural success and risk. WML should not be used to render treatment decisions in otherwise eligible patients. Aggressive monitoring of medical complications after MT could represent a viable strategy to improve outcome in affected patients.

  • stroke
  • statistics
  • thrombectomy
  • CT angiography

https://doi.org/10.1136/neurintsurg-2020-015940

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    Footnotes

    • ZA and JM contributed equally.

    • Contributors JM, MN, DKJ, MUA, ASP, and NH acquired the data. ZA, JM, and NH were involved in the study design and data interpretation. ZA and NH drafted the article. NH conducted statistical analyses. All authors commented on the manuscript for important intellectual content.

    • Funding K08NS091499 from the National Institute of Neurological Disorders and Stroke of the National Institutes of Health (NH).

    • Disclaimer The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

    • Competing interests ASP is a consultant for Medtronic, CereVasc, Microvention, Stryker Neurovascular, Scientica Vascular, and Cerenovus, receives research support from Stryker Neurovascular and Medtronic Neurovascular, and reports stock options in InNeuroCo.

    • Patient consent for publication Not required.

    • Ethics approval This study was reviewed and approved by the authors' Institutional Review Board and procedures followed were in accordance with institutional guidelines and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. Health Insurance Portability and Accountability Act (HIPAA) waiver of authorization was granted. The authors adhere to the STrengthening the Reporting of OBservational studies in Epidemiology (STROBE) guidelines (www.strobe-statement.org).

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement The investigators will share anonymized data (with associated coding library) used in developing the results presented in this manuscript upon reasonable request to investigators who have received ethical clearance from their host institution.